Tirzepatide and semaglutide, two glucagon-like peptide-1 (GLP-1) receptor agonists, have been associated with similar risks of asthma flare-ups in adults with asthma and type 2 diabetes (T2D). A study published in the Journal of Asthma and Allergy assessed the association between these two medications and the risk of asthma exacerbations in patients with both conditions.
Asthma and T2D often coexist, with approximately 13% to 16% of patients having both conditions. This coexistence is significant, as patients with both conditions tend to experience poorer asthma control, more severe exacerbations, and greater healthcare utilization compared to those with asthma alone.
Asthma and Obesity
Patients with obesity and asthma are at increased risk for worsening asthma severity and potential reduction in response to regular asthma therapies.
According to Khalilah Gates, MD, a pulmonary and critical care specialist, extra weight around the lungs can compromise airway openness and make it harder to expand the lungs. Additionally, adipose tissue can release hormones and signaling molecules that cause inflammation and worsen airway inflammation in patients with asthma.
GLP-1 therapies, such as semaglutide and tirzepatide, may have effects beyond weight loss and glycemic control, including reducing the risk of asthma exacerbations. Data supporting the potential respiratory effects of these agents have grown in recent years, with several studies reporting better asthma outcomes among patients using them.
Study Findings
A retrospective cohort study analyzed electronic health record data from the TriNetX US Collaborative Network, involving over 65 healthcare organizations in the US. The study included patients older than 18 years with both asthma and a T2D diagnosis who used tirzepatide or semaglutide between June 2022 and December 2024. The primary outcome was time to first asthma flare-up during the 12-month follow-up.
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Among 455,196 patients with asthma and T2D, 8,178 received tirzepatide and 28,135 received semaglutide. Following propensity score matching, 8,176 patients were included in each group. After follow-up, asthma flare-ups occurred in 11% of patients receiving tirzepatide and 11.1% of participants receiving semaglutide.
Although the two drugs showed similar asthma flare-up risk, tirzepatide was associated with an 8% lower risk for short-acting beta-agonist (SABA) use. However, corticosteroid use was similar between the groups. The lower SABA use with tirzepatide may indicate differences in asthma-related symptoms or treatment requirements.
Clinical Practice Considerations
In patients with difficult-to-control asthma and/or asthma with frequent exacerbations and obesity, GLP-1s should be considered. According to Dr. Gates, it is essential to understand the current indications for their use, which is not asthma, but patients with other comorbidities and asthma could benefit from the weight loss observed with these medications.
Healthcare providers should continue to follow the current recommendations for use of GLP-1 drugs. In patients with the current indications and the presence of persistently symptomatic asthma, the current understanding of GLP-1s’ impact on asthma control should be considered. These medications should be prescribed in addition to maximizing guideline-based treatment recommendations, not instead of.
The director of the Clinical Research Program in the Division of Allergy and Immunology at the University of Wisconsin Hospitals, Mark Moss, noted that preliminary studies suggest that the benefits of GLP-1 medications may extend to asthma control. However, there is a need for well-designed, randomized clinical trials to be performed before any firm recommendations can be made regarding their use specifically for asthma.